Q: Good day ma’am. Thanks for always giving detailed answers to questions asked. I’m 30 weeks pregnant but my tummy is not big. Before the pregnancy got to 30 weeks I experienced spotting which spot. Now I am spotting. What causes spotting in pregnancy in the second and third trimester? Does it have effect on the baby? Went for check-up. My doctor says the baby is fine. Please hide my identity. Kudos ma’am

A: Thanks for writing in.

You were super smart to have gone to complain to your doctor. If he says, all is well, that’s great. But I will just talk generally about bleeding in pregnancy

Bleeding in late pregnancy may be due to a variety of issues ranging from infections to the ‘show’ that heralds the start of labour.

Causes of bleeding at this time include:

1. Cervical changes which can lead to bleeding after sexual intercourse
2. Infection of the cervix
3. Infection of the vagina

Other causes include:

• Placenta previa.
• Placental abruption.

These are two conditions that affect the placenta.

The placenta is created during pregnancy and is attached to the wall of the uterus (the womb) by blood vessels. It is through the placenta that the baby receives vital nutrients and oxygen and also through this that it excretes waste products. The baby is connected to the placenta through the umbilical cord. So this is a pretty important organ in the general scheme of things. The baby’s and mother’s blood do not mix in the placenta usually, though. The baby’s blood flows on one side and the mother’s on the other side.

The placenta usually implants at the top part of the uterus or the side, but in placenta previa the placenta attaches low in the uterine wall and covers the mouth of the womb (the cervix) partially or completely. It could be just low lying, near the cervix but not covering it, just covering part of the cervix or fully covering it. Due to this abnormal placenta position, pregnant women with PP would show up in hospital with bright red vaginal bleeding which may happen with or without contractions.

What causes this? Well, in instances where the placenta is bigger than normal or in cases where surgery had been performed on the uterus. Thus, women with multiple pregnancies (twins, triplets etc), who have had fibroid surgery or previous Caesarian Section, who have had children before may be at risk of this. Other risk factors include age at pregnancy older than 35 years, smoking, use of cocaine etc.

The doctor (obstetrician) will order a scan to confirm the diagnosis. Low lying placenta that hardly get to the opening of the cervix can actually be ‘drawn’ up as the uterus expands to accommodate the growing baby in it. However, the women with complete PP are most likely to go through Caesarian Section.

Can you prevent it? No, you really can’t 😀 What to do? Once you notice any vaginal bleeding, please be sure to see your doctor. PP is likely to cause bleeding from sometime around the second trimester of pregnancy, but of course, every episode of bleeding in pregnancy, irrespective of trimester, should be checked out in the hospital. Depending on the severity of the bleeding and the age of the pregnancy, the doctor would decide whether bed rest or emergency Caesarian section would be applicable. If bed rest is recommended, sexual intercourse and physical exertion including exercise, at this time may not be wise. Please discuss this with your doctor.

You’ve got to make sure that the person with PP is under the care of a good obstetrician. This is not the time to play hooky and try out different treatment options from unorthodox practitioners (not that any time is a good time, anyway :D). It may very well be that if the bleeding continues significantly, the baby may be delivered pre-term. So you have to be in a center that is equipped to handle that eventuality. Better safe than sorry 😀

In placental abruption, the placenta separates, completely or partially, from the wall of the uterus before the baby is born. This situation is not very common but when it does happen, it can deprive the baby of vital nutrients and oxygen and lead to bleeding in the mother. This situation may happen suddenly or may develop gradually with symptoms like vaginal bleeding, abdominal and/or back pain, sore uterus, fewer baby movements, contractions etc

We don’t really know the cause of placental abruption apart from the fact that it could be caused by trauma to the abdomen. Other risk factors include:
• A previous history of placental abruption
• Multiple pregnancy
• Premature rupture of membranes
• Substance abuse eg smoking
• Maternal age greater than 40 years

Now, remember that having a risk factor doesn’t automatically mean that you will come down with the ‘disease’.

Treatment depends on the severity of the abruption, the age of the pregnancy and the effect on the baby. Your doctor will make the call as to whether to go for an emergency Caesarian Section or keep patient on bed rest while waiting for baby to mature some more, depending on these factors.

Can this be prevented? Well, given the fact that we’re not quite sure of the cause, we can’t really do much other than try to guide against risk factors that can be prevented like not smoking.
Just be sure to let your doctor know that you have had this problem before so he can be extra watchful. With the right care, you should be fine.

So, I suggest you go see your obstetrician to confirm that this bleeding is nothing serious, if it continues

Have a great night, y’all 😀